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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010213011
Report Date: 12/15/2023
Date Signed: 12/15/2023 10:02:02 AM

Document Has Been Signed on 12/15/2023 10:02 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND SOUTH EAST, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:YMCA OF THE EAST BAY Y-KIDS CASTRO VALLEYFACILITY NUMBER:
010213011
ADMINISTRATOR:WILLIAMS, LATASHIAFACILITY TYPE:
840
ADDRESS:20185 SAN MIGUEL AVENUETELEPHONE:
(510) 881-4458
CITY:CASTRO VALLEYSTATE: CAZIP CODE:
94546
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 0DATE:
12/15/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Rose Kekaula-AkotueTIME COMPLETED:
10:15 AM
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On 12/15/2023 at 8:30am, Licensing Program Analyst (LPA) Christina Uribe conducted an unannounced Plan of Correction visit and met with site director, Rose Kekaula-Akotue. Also present during today's inspection is Program Director, Vicki Coster. The purpose of today's visit is to clear plan of correction for 4 Type B Violations that were issued on 12/01/2023.

Through record review, LPA verified that 3 of the 4 Type B Violations were corrected. Letter of Deficiency Citations Clearance forms were signed and given to the facility for proof of clearance. LPA obtained Criminal Background Clearance Transfer Request (LIC 9182) forms for three staff members provided by the Program Director. LPA will transfer these criminal background clearances upon returning to the Regional Office the next business day. Upon the completed transfer of these criminal background clearances, LPA will approve the clearance of the fourth violation issued on 12/01/23 and will email Program Director these letters.

LPA obtained relevant documents for the director packet. Director and Program Director asked LPA various questions related to licensing and LPA provided consultation.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the director, Rose Kekaula-Akotue.







Page 1 of 1 ***End of Report***
SUPERVISORS NAME: Chandra Charles
LICENSING EVALUATOR NAME: Christina Uribe
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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